Abortion (Termination of Pregnancy) reimbursement
This policy governs reimbursement for induced and non-induced abortion-related procedures for Anthem Medicare Advantage members where not overridden by provider, state, federal, or CMS contracts; it applies to providers submitting claims to the listed Medicare Advantage jurisdictions.
No material clinical or coverage changes in this revision.
Induced and Non‑Induced Abortion Coverage Criteria
Induced and non-induced abortion coverage criteria
Induced abortions are reimbursable under Anthem Medicare Advantage when the requirements below are met and are subject to applicable provider, state, federal, or CMS contracts and requirements.
ALL of the following
- Written voluntary and informed consent must be obtained from the woman upon whom the abortion is to be performed (for induced/elective abortions).
ONE of
- Pregnancy is the result of an act of rape or incest, as certified by the provider performing the procedure.
- The woman has a physical disorder, injury, or illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.
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